Oral Cancer News

Head and neck cancer is more common than you think

Source: www.irishtimes.com
Author: Jamie Ball

Well over 1,000 people in Ireland are diagnosed each year with cancers of the head and neck, with almost three-quarters of cases being attributed to smoking and alcohol. Yet this pernicious form of cancer very often goes under-reported, or sufficient heed isn’t paid to the warning signs that, if caught early, may be the difference between life and death.

This is why July 27th will mark the third World Head & Neck Cancer day, taking place across 53 countries. The 2017 National Cancer Strategy highlights the importance of prevention, detection and diagnosis, and education and awareness is key for early recognition of the disease.

According to James Paul O’Neill, Prof of Otolaryngology, Head and Neck Surgery in Beaumont Hospital, Dublin and the Royal College of Surgeons in Ireland, there can be many different types of cancers within the head and neck, each with their own tissue characteristics and biological behaviour.

“Cancers may develop in several areas of this region, including the mouth, throat, larynx (voice box), glandular tissue (thyroid), salivary tissue (parotid gland), lymphatic tissue, nose, sinuses and skin. Patients have a large variety of symptoms and signs according to the subsite of the disease,” says O’Neill.

He says surgery incorporates many different techniques and skills, as the region has essential functional roles, such as talking, breathing, smelling, hearing, chewing and swallowing.

“We are now in the age of highly-specialised technological innovations. There is a drive towards minimally invasive surgery because we can perform the same surgery except with reduced morbidity to surrounding structures.

“Chemotherapy overall offers little in head and neck oncology, with an overall survival difference of approximately 6.5 per cent, but a hike in morbidity of nearly 50 per cent.

“Overall, some head and neck cancers have an excellent prognosis, but unfortunately two-thirds of all our patients present with advanced disease at the time of diagnosis. If these patients fail our first line of therapy, their prognosis is often very challenging. Head and neck cancers often advance quickly and given the anatomical complexity of the region, frequently impinge on or directly invade the patient’s airway,” says O’Neill.

Following a diagnosis of Laryngeal cancer in 2014, Sligoman Donal Connor had his larynx removed in Beaumont Hospital, under the care of Prof O’Neill and plastic surgeon Barry O’Sullivan. Despite his diagnosis, Connor had never smoked, and remained fit and active all his life.

“This was life-changing surgery, but it gave me a chance to have a life and get rid of this tumour, which was making me hoarse and very unwell,” says Connor. “I now have a little prosthesis, or speaking valve, in my neck, which helps to project my voice. I have to put my finger in the hole in my neck, which is called a stoma, every time I want to speak, which can be very tiring. Conversation for me is the biggest challenge, as I cannot raise my voice if I need to call someone, and I cannot speak over the radio, television or in a crowded situation,” says Connor.

“I now breathe through the stoma, which must be cleaned and cared for on a daily basis, and so it’s much easier for me to get chest infections. I understand my neck looks different and people stare at it, but by now I’m used to this type of attention.”

Connor says his sense of smell has been impacted hugely, while going for a swim is no longer an option either. “If water enters my stoma it would flood my lungs. I have to take great care in the shower. My stoma needs to be covered at all times around water. I am very lucky I can eat and drink most things, but I have to relax after my meals or my food will repeat on me. I cannot speak during mealtimes as I need to focus on swallowing.

“Regardless of all these negatives, I am thankful to God every day to be cancer free and given this second chance. I could go around all day depressed, and some days I do, but I try my best to make the most out of the life I have been left with,” says Connor.

“I know I had different treatments and surgeries that weren’t successful for me, but what didn’t work for me may be very successful for other cancer patients, as everyone’s cancer is different. I know now that anyone who is hoarse for more than six weeks should have it investigated. Please go to your GP, or further if needs be, and have it checked out. It may be nothing to worry about, but if it is detected early, its half the battle.”

Print Friendly, PDF & Email

The Bogus Medicines the Feds Have No Plan to Stop

Source: http://www.thedailybeast.com/the-bogus-medicines-the-feds-have-no-plan-to-stop
Date: July 22, 2017
Author: Paul A. Offit

In a better world, the FDA would regulate homeopathic products. It would certainly be a lot cheaper and just as effective.

Homeopathic products are big business, grossing at least $3 billion a year. A 2007 survey estimated that 3.9 million adults and 910,000 children used them. These figures have only increased during the past 10 years.

One uncomfortable fact about homeopathic products, which are substances meant to treat patients by mimicking the symptoms of an illness, is that the Food and Drug Administration (FDA) doesn’t regulate them. This means that:

  • Manufacturers are not required to submit a new drug application before selling them.
  • Manufacturers are exempt from meeting Good Manufacturing Product (GMP) standards.
  • Manufacturers are exempt from finished-product testing for identity and strength.
  • And, as an added bonus, homeopathic products are allowed to contain higher amounts of alcohol than other drugs.

Because no one is looking, poorly made and dangerous products slip through. In 2012, for example, 10,000 cases of “poison exposures” were reported; most occurred in children who were less than five years old and some required medical treatment.

For these and other reasons, the FDA held a meeting on April 20 and 21, 2015, to discuss the regulation of homeopathic products. The FDA sought “written comments from all interested parties, including, but not limited to, consumers, patients, caregivers, health care professionals, patient groups, and industry.” With so many competing interests in the room, it shouldn’t be surprising that nothing happened. Nonetheless, about a year and a half after the FDA meeting, on Nov. 15, 2016, the Federal Trade Commission (FTC) took a stand, declaring that homeopathic products cannot include claims of effectiveness without competent and reliable scientific evidence. If no evidence existed (which is always the case), this fact must be clearly stated on the label.

In order to understand homeopathic products and the controversies that surround them, we need to go back to the beginning.

Homeopathy was the creation of Samuel Hahnemann, who practiced in Germany and France between 1779 and 1843. Hahnemann was disturbed by the brutality of 19th-century medicine, which included bloodletting, leeches, emetics, cathartics, and skin blistering with acids. He wanted a safer, better way to treat his patients.

Hahnemann’s epiphany came in 1790. While eating powder from the bark of a cinchona tree, Hahnemann developed a fever. At the time, it was known that cinchona bark, which contained quinine, could treat malaria. Hahnemann believed that because cinchona bark had caused him to have fever, and because fever was a symptom of malaria, medicines should induce the same symptoms as the diseases they were treating. For example, vomiting illnesses should be treated with medicines that cause vomiting. (Homeopathy literally means “similar suffering.”) To be on the safe side, however, Hahnemann also believed that homeopathic medicines should be diluted to the point that they aren’t there anymore. Although the active ingredient was gone, Hahnemann believed that the final preparation would be influenced by the fact that the medicines had once been there. In other words, the water in which the product was diluted would remember. (Given the finite amount of water on earth, it’s comforting to know that it doesn’t actually remember where it’s been.)

To understand how homeopathic products are made, let’s look at one popular product made by Boiron, a French company that describes itself as a “world leader in homeopathic medicines.” The product is called Oscillococcinum.

Boiron makes Oscillococcinum by homogenizing the heart and liver of a Burberry duck, diluting it in water 100-fold, and then repeating the hundred-fold dilution 200 more times. A solution this dilute doesn’t contain a single molecule of the Burberry duck. In fact, the preparation is so dilute that not a single molecule of the duck would be found if the final volume were that of the universe (about 1080 cubic meters). The duck is gone. From a scientist’s standpoint, Oscillococcinum is one gram of sugar. Nonetheless, a pack containing six “doses” of Oscillococcinum costs $8.00. So it’s really expensive sugar.

The label for Oscillococcinum claims that it “reduces the duration and severity of flu symptoms,” including “body aches, headache, fever, chills, and fatigue.” At the end of these claims is a small superscripted asterisk that refers the consumer to an equally small statement on the back of the box: “These ‘Uses’ have not been evaluated by the Food and Drug Administration.”

Promoters of Oscillococcinum argue that the product is of value if only because it’s a lot safer than other remedies out there, many of which are quite harmful. For example, some doctors will prescribe an antibiotic, like the all-too-conveniently-named Z-Pack, which contains azithromycin. Antibiotics can cause allergic responses or select for resistant bacteria. Worse, some parents will use over-the-counter cough-and-cold preparations. In 2007, the FDA issued a warning against these preparations in young children—a warning long overdue. Between 2004 and 2005, the CDC found that more than 1,500 young children had suffered hallucinations, seizures, and heart problems caused by cough-and-cold medicines containing stimulants like pseudoephedrine. Three children died as a result. Further, these products do little to relieve symptoms. Oscillococcinum, on the other hand, doesn’t cause any of these side effects.

When people suffer adverse reactions to homeopathic products, like the poisonings referred to above, it’s because they aren’t really homeopathic. In other words, they might contain an active drug. Because homeopathic products aren’t regulated, consumers are on their own.

The worst aspect of homeopathic products is when people use them to treat conditions that should be treated with real drugs, like antibiotics for bacterial infections or bronchodilators for asthma or steroids for severe eczema. Or, as was the case for a 45-year-old woman named Penelope Dingle in Australia, chemotherapy for a treatable cancer. Dingle paid for her choice with her life.

In a better world, the FDA would regulate homeopathic products. Manufacturers would have to meet labeling and manufacturing standards and products would have to be proven to be safe and effective before they could be sold. If this happened, homeopathic products would disappear from the shelves. Then, patients or parents would have to use their own water or sugar to treat themselves and their children. It would certainly be a lot cheaper and consumers can be reassured that it would be just as effective.

Paul A. Offit, MD, is director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and the author of Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine (HarperCollins, 2013).

Print Friendly, PDF & Email
July, 2017|Oral Cancer News|

Teens drink less if they know alcohol causes cancer — but most don’t — study finds

Source: http://www.adelaidenow.com.au/
Author: Tim Williams, Education Reporter

Teens are less likely to drink if they know that alcohol is a major cause of cancer, but most are unaware of the link, a South Australian study has found. More than 2800 school students aged 12-17 were surveyed about their drinking behaviour by Adelaide University and South Australian Health and Medical Research Institute (SAHMRI) researchers.

Those aged 14-17 were deterred from drinking if they knew about the link between alcohol and cancer, but only 28 per cent of students were aware of the connection. Parental disapproval was another deterrent, while smoking and approval from friends resulted in higher rates of drinking. Most students had tried alcohol by age 16 and a third drank at least occasionally. Wealthy students were more likely to drink.

Cancer Council SA chief executive Lincoln Size said there was clear evidence drinking caused cancers of the mouth, pharynx, larynx and oesophagus, as well as bowel cancer in men and breast cancer in women. It likely raised the risk of liver cancer and bowel cancer in women too.

“Any level of alcohol consumption increases the risk of developing an alcohol-related cancer; the level of risk increases in line with the level of consumption,” he said.

“This latest evidence highlights the need to educate young people about the consequences of alcohol consumption and for parents to demonstrate responsible drinking behaviour.

“We need to get the message through that what may be considered harmless fun actually has lifelong consequences.”

Lead author Jacqueline Bowden, a behavioural scientist with both the uni and SAHMRI, said drinking patterns were often set in adolescence.

“With alcohol contributing to four of the top five causes of death in young people, and a leading cause of cancer in our community, it’s important for us to better understand drinking behaviour among young people so we can help to prevent or delay it,” Ms Bowden said.

“One of the major messages from our study is that parents have more influence on their teenagers’ decisions regarding alcohol than they probably realise.

“Parental behaviour and attitudes towards alcohol really do make a difference, and can help prevent children from drinking at an early age.

“Many parents believe providing their children with alcohol in the safe environment of their home teaches them to drink responsibly.

“However, the weight of evidence suggests that this increases consumption, and is not recommended.

“Our results also found that those adolescents who thought they could buy alcohol easily were more likely to drink regularly. The issue of availability — including price — and marketing of alcohol in the community is a major hurdle to be overcome.”

The findings of the study, which was supported by Cancer Council SA and the State Government, have been published in the journal BMC Public Health.

Print Friendly, PDF & Email

Plan not to give HPV vaccine to boys causes concern

Source: http://www.bbc.com/news/health-40658791
Date: July 19th, 2017

A decision not to vaccinate boys against a cancer-causing sexually transmitted infection has attracted fierce criticism.

Reported cases of human papilloma virus (HPV) – thought to cause about 80% of cervical cancers – have fallen sharply since girls were given the vaccine.

But the Joint Committee on Vaccination and Immunisation (JCVI) found little evidence to justify treating boys too.

Critics said vaccinating boys could help reduce the risk still further.

Across the UK, all girls aged 12-13 are offered HPV vaccination as part of the NHS childhood vaccination programme.

Mary Ramsay, head of immunisation at Public Health England, said: “Evidence from around the world suggests that the risk of HPV infection in males is dramatically reduced by achieving high uptake of the HPV vaccine among girls.

“While there are some additional benefits to vaccinating both males and females, the current models indicate that extending the programme to boys in the UK, where the uptake in adolescent girls is consistently high (over 85%), would not represent a good use of NHS resources.”

This initial recommendation by JCVI will now be subject to a public consultation and a final decision will be made in October.

The British Dental Association said it would urge the committee to reconsider the evidence.

The chair of the BDA, Mick Armstrong, said: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible.”

Shirley Cramer of the Royal Society for Public Health said: “We are deeply disappointed by the JCVI’s decision today, which suggests that fundamental priorities are focused more on saving money than on saving lives.

“Such a simple vaccination programme has the potential to make such a big impact on the public’s health on a national scale.

“We hope that the government’s advisory committee reconsider this decision as soon as possible and put the public’s health and wellbeing before cost-saving.”

The argument for vaccinating boys HPV

  • About 15% of UK girls eligible for vaccination are currently not receiving both doses, a figure which is much higher in some areas
  • Men may have sex with women too old to have had the HPV vaccination
  • Men may have sex with women from other countries with no vaccination programme
  • Men who have sex with men are not protected by the girls’ programme
  • The cost of treating HPV-related diseases is high – treating anogenital warts alone in the UK is estimated to cost £58m a year, while the additional cost of vaccinating boys has been estimated at about £20m a year

Source: HPV Action

Print Friendly, PDF & Email
July, 2017|Oral Cancer News|

Richard Holbrook’s Benefit Concert To Give All Proceeds to The Bruce Paltrow Oral Cancer Fund

NEWPORT BEACH, Calif., July 13, 2017 /PRNewswire-USNewswire/ — Acclaimed cabaret singer Richard Holbrook will be performing two benefit concerts at the Metropolitan Room in New York City on Friday, September 8, 2017 at 7:00pm and Saturday, September 9, 2017 at 4:00pm as a benefit for The Bruce Paltrow Oral Cancer Fund which is connected with The Oral Cancer Foundation.

Holbrook will be singing Richard Rodgers songs from classic Broadway shows and memorable Hollywood film musicals. “I’m so thrilled and excited to be performing my show as a benefit for the Bruce Paltrow Oral Cancer Fund,” he states. Holbrook will be accompanied by the fabulous Tom Nelson Trio.

The stage 4 oral cancer survivor found a canker sore which led to a cancer diagnosis, spreading from gum to jaw. In September 2013 Holbrook stated, “After the surgery, I couldn’t utter a sound. I wrote notes to my family, but they were illegible. I got so frustrated! I now have such empathy for people with conditions that keep them from being able to communicate with the world. One of the most enlightening lessons I learned is how important communication is. As singers, it is all about HOW we communicate through words, sound and storytelling.”

About Richard Holbrook

Born in New York City, Richard taught himself how to sing by listening to the recordings of Fred Astaire, Judy Garland, and Bing Crosby and by watching their films. He found success as an actor on such hit television series as The Sopranos and Spin City, and a passion for performing cabaret which led to his first CD entitled Richard Holbrook Steps Out in 2004. Over the past several years, Richard, a three-time MAC Award nominee for best male vocalist, has appeared at popular Manhattan night spots such as Danny’s Skylight Room, Don’t Tell Mama and of course the Metropolitan Room.

About the Metropolitan Room

This Flatiron “class act” aims to revive the “golden age of cabaret” as “up-and-coming stars” and “renowned performers” alike take the stage in an “intimate” room with “great acoustics”; run with “professionalism” by a “gracious staff”, it’s “worth every penny” for a “sophisticated” night out. – ZAGAT 2014

The Metropolitan Room, 34 West 22nd St.  (Bet. 5th & 6th Aves) New York, NY 10010

For Tickets: Use this website,  www.MetropolitanRoom.com

For Reservations: 212.206.0440

About the Oral Cancer Foundation

The Oral Cancer Foundation, founded by oral cancer survivor Brian R. Hill, is an IRS registered non-profit 501 (c) (3) public service charity that provides information, patient support, sponsorship of research, and advocacy related to this disease.  Oral cancer is the largest group of those cancers that fall into the head and neck category. Common names for it include such things as mouth cancer, tongue cancer, head and neck cancer, and throat cancer.  OCF maintains a web site at http://www.oralcancer.org, which receives millions of hits each month.  Supporting the foundation’s goals is a scientific advisory board composed of leading cancer authorities from varied medical and dental specialties, and from prominent educational, treatment, and research institutions in the United States.

Print Friendly, PDF & Email
July, 2017|Oral Cancer News|

Trans oral robotic surgery saves public Australian hospital patients from disfiguring procedure

Source: www.smh.com.au
Author: Kate Aubusson

The cancerous tumour growing at the back of Brian Hodge’s tongue was about as hard-to-reach as cancers get. The 73-year-old was told he’d need radical, invasive surgery to remove the 50¢-sized tumour. His surgeon would make an incision almost from ear-to-ear and split his jaw in two for the 10-12 hour surgery.

After five days in intensive care, another three weeks in hospital and four to six months recovery, re-learning how to eat and talk Mr Hodge would have been left with disfiguring scars, and a voice that he may not recognise as his own.

“My kids didn’t want me to have it,” Mr Hodge said. “But I’m not one to throw in the towel … Then the unbelievable happened,” he said.

Mr Hodge became one of the first public patients to undergo robotic surgery for head, neck and throat cancer at Nepean Hospital, the state’s only hospital offering the service to patients who can’t afford private healthcare.

Mr Hodge’s surgeon, Associate Professor Ronald Chin, performed the trans oral robotic surgery (TORS) by guiding the robot’s arm into his patient’s open mouth to remove the cancerous tumour.

“I went in on Monday morning for the surgery and I was discharged Tuesday night,” Mr Hodge said of his surgery performed on June 19.

“It’s just amazing. Two days compared to six months recovering.

“What’s got me is that before it was only available to people who could pay the big money. I’ve worked all my life, I’ve paid tax and I think, why can’t we people get this surgery as well,” he said.

TORS is available for private health patients in other NSW hospitals, but its use at a major tertiary hospital in Sydney’s west – surrounded by suburbs with some of the highest smoking rates and lowest private health insurance rates in Sydney – was significant.

“It’s an enormous step forward to be able to offer this state-of-the-art treatment with such obvious benefits both cost-wise and [avoiding] disfigurement-wise … to patients who may not have previously had the resources to access it,” Dr Chin said.

The da Vinci robot Dr Chin used was the same one Nepean Hospital’s urological surgeons use to perform prostatectomies on prostate cancers. The TORS procedure takes about 45 minutes.

“Traditionally surgery is incredibly invasive. We had to make very large incisions across the neck, then lift the skin well above the lower lip and cut the jaw open,” said the otolaryngology, head and neck surgeon.

“We’re talking about a massive operation. Then reconstruction is very difficult.

“Not only did people face a horrendously long operation, they had to deal with long post-operative recovery and rehabilitation to regain speech, language, voice and the ability to eat and drink.

“With TORS, patients can go home the next day [with minimal discomfort],” he said.

More than 400,000 cases of oropharyngeal squamous cell carcinomas are diagnosed each year worldwide. The five-year survival rate for head and neck cancer in Australia is 69 per cent, according to government estimates.

Nepean Hospital would see between 10 and 15 patients with head and neck cancers per year who would be suitable for TORS, Dr Chin said. The cancerous tumours, usually linked to smoking and excessive drinking as well as the human papilloma virus, were “extraordinarily difficult to access, almost impossible”, said Dr Chin.

Robotic surgery costs significantly more than traditional surgeries. But Dr Chin said TORS could save the public health system up to $100,000 per procedure, where patients no longer needed to spend days in ICU, costing more than $3000 per night, or weeks in hospital. The robotic surgery is primarily indicated for patients with oropharyngeal carcinomas of up to four centimetres in size. Roughly one-third of TORS patients will not need chemo and radiotherapy.

“The early evidence available on trans oral robotic surgery for oropharyngeal cancer is promising,” said Dr Tina Chen, medical and scientific adviser at the Cancer Institute NSW.

“However, higher-quality research is needed to definitively say whether it means better clinical outcomes for patients, compared to other treatments already available,” she said.

There was currently no high-quality evidence from randomised controlled trials comparing TORS to chemotherapy and radiotherapy for these types of cancers, a 2016 Cochrane review concluded. It noted “data are mounting”.

Mr Hodge will soon be able to swap the pureed food he has eaten since the day after his surgery for his favourite meal, barbecue chicken, and the avid karaoke singer is already planning his first post-surgery crooning set-list. First, Engelbert Humperdinck’s Please Release Me, and the song he has been singing to his wife for decades, Anne Murray’s Could I Have This Dance.

Print Friendly, PDF & Email

Smoking Scenes in Movies Have Increased … Why?

Source: www.healthline.com
Author: Shawn Radcliffe

After several years of decline, tobacco use depicted in movies is on the rise again. Does it matter? Where there’s smoke, there’s … probably a PG-13 rated movie.

A new study shows that tobacco incidents depicted in top-grossing movies in the United States are once again on the rise, breaking an earlier decline. This is true despite public health efforts outside theaters to reduce smoking by children and teens.

“If the progress that we had seen between 2005 and 2010 had continued, all of the youth-rated films would have been smoke-free in 2015,” said study author Stanton Glantz, PhD, professor of medicine, and director of the University of California San Francisco (UCSF) Center for Tobacco Control Research and Education.

The July 7 study in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR) found that the total number of tobacco incidents in top-grossing movies increased 72 percent between 2010 and 2016. It also increased 43 percent in PG-13 movies. Tobacco incidents are defined as use or implied use, by an actor, of cigarettes, cigars, pipes, hookah, smokeless tobacco products, or electronic cigarettes. This increase comes as the number of movies showing tobacco declined — meaning fewer movies account for a greater number of tobacco scenes.

In 2016, 41 percent of the top-grossing movies had tobacco incidents, down from 45 percent in 2010. In addition, 26 percent of youth-rated movies had tobacco incidents in 2016, a decline from 31 percent in 2010. Tobacco incidents in top-grossing movies peaked in 2005. The lowest number of tobacco incidents on record occurred in 1998. Tobacco depictions are now rare in PG and G movies — only four of these films in 2015 included tobacco use.

The study was a collaboration between UCSF, the Centers for Disease Control and Prevention (CDC), and Breathe California of Sacramento-Emigrant Trails, which provided the data.

The potential harm:
Like on-screen violence, tobacco depicted in youth-rated movies can have a profound effect on children and teens.

“It’s very concerning because five years ago in 2012 the surgeon general concluded that exposure to smoking on-screen in movies causes kids to start smoking,” Glantz told Healthline.

There’s also a dose-response — the more often kids see tobacco use depicted in movies, the more likely they are to pick up the habit. According a National Cancer Institute (NCI) report, youths who are heavily exposed to smoking depicted in movies are two to three times more likely to start, compared with kids who have little exposure.

“An increase in the amount of exposure means that more kids are going to be smoking and dying from tobacco-induced diseases,” said Glantz.

Tobacco use is linked to lung cancer, mouth cancer, emphysema, and other diseases. The NCI report also cited studies showing that cigarette smoking in movies can influence adults’ and teens’ beliefs about smoking. For example, when stars are shown smoking, or when the health consequences of tobacco don’t show up in the film, viewers may develop pro-smoking beliefs and intentions.

What’s causing the increase?
The increase in the number of on-screen tobacco incidents since 2010 runs counter to overall smoking trends in the United States. According to the CDC, overall smoking rates in adults have been falling for decades, and in high school students since the late 1990s. The researchers write that starting in 2001 public health officials became more concerned about tobacco use in movies. This might account for the decline of tobacco incidents in youth-rated movies between 2005 and 2010.

So what has shifted in recent years?
Some public health experts put the blame squarely on the motion picture companies that continue to produce youth movies depicting smoking.

“I think the [public health] messaging is fine,” said Glantz. “It’s been the recalcitrance on the part of the media companies to act responsibly and protect kids.”

The major studios have policies to help reduce the amount of smoking in movies that they release, but all of the polices have what Glantz calls “loopholes.” Paramount Pictures “discourages” depiction of tobacco use in youth-rated films, but also takes into account the “creative vision of the filmmakers.” Universal Pictures “presumes that no smoking incidents should appear” in youth-rated films, but leaves it as an option if there is a “substantial reason for doing so.”

Modernizing movie rating system:
Currently, the Motion Picture Association of America (MPAA), which rates movies in the United States, has a smoking “rating descriptor” that is supposed to alert viewers and parents to tobacco use in a film. However, this descriptor was missing from 89 percent of top-grossing, youth-rated movies that depicted tobacco use, according to a 2015 report by the UCSF Center for Tobacco Control Research and Education.

Public health experts are calling for a more consistent approach.

“The six studios that control the rating system through the MPAA need to modernize the rating system to reflect the science,” said Glantz, “and give an R-rating for smoking, which would get it out of all the youth-rated movies.”

A 2012 study in the journal Pediatrics estimated that this could reduce the number of teen smokers by 18 percent. A related CDC fact sheet estimated that this change would save the lives of a million youth. Advocacy group Smokefree Movies recently ran a two-page statement in The Hollywood Reporter and Variety demanding that MPAA update the rating system by June 1, 2018. The statement was signed by the American Academy of Pediatrics, the American Heart Association, and other health organizations.

So far, the major studios have been unwilling to update the rating system to take into account on-screen tobacco use. Some health experts have proposed running anti-smoking messages before movies to counteract the effect of on-screen tobacco use. These are somewhat effective but would require much more effort than reducing children’s on-screen tobacco exposure.

“It would cost nothing to [update the rating system],” said Glantz. “There’s no public health intervention that would be cheaper and have a bigger effect.”

Print Friendly, PDF & Email

Improved quality of life for head and neck cancer patients with Nivolumab

Source: www.oncnursingnews.com
Author: Jason Harris

Patients with head and neck squamous cell carcinoma (HNSCC) saw improved or stable quality of life (QOL) scores following treatment with single-agent nivolumab (Opdivo), according to results published in Lancet Oncology.1

In contrast, patients assigned to investigator’s choice of treatment saw clinical meaningful declines, defined as a decrease in ≥10% from baseline, across 8 of 15 (53%) domains on the EORTC QLQ-C30 questionnaire.

“The results of CheckMate-141 suggest that nivolumab is the first PD-1 inhibitor, to our knowledge, to show a significant improvement in overall survival, with better tolerability and a quality-of-life benefit, compared with standard therapy for platinum-refractory recurrent or metastatic squamous cell carcinoma of the head and neck,” investigators wrote. “In view of the major unmet need in this population and the importance of maintaining or improving quality of life for patients with recurrent or metastatic squamous cell carcinoma of the head and neck, these data support nivolumab as a new standard of care option in this setting.”

Investigators evaluated statistical differences in patient-reported adjusted mean changes from baseline between treatment groups as assessed by the EORTC QLQ-C30, EORTC QLQ-H&N35, and EQ-5D-3L at each time point, and the time to clinically meaningful deterioration per each individual scale’s criteria.

Patient assessments were conducted before treatment initiation, at week 9, and then every 6 weeks during the treatment period using the EORTC QLQ-C30, EORTC QLQ-H&N35, and EQ-5D-3L questionnaires. Posttreatment assessments were made at follow-up visits 1 and 2 (35 days give or take 7 days after the last treatment dose, and 80 days give or take 7 days after follow-up visit 1). The EQ-5D-3L questionnaire was also administered at survival follow-up visits (every 3 months give or take 7 days after follow-up visit 2). Patients completed their assessments at each time point before physician contact, treatment dosing, or any procedures.

Thirty-six patients assigned to investigator’s choice of treatment with platinum-based chemotherapy and 93 patients assigned to nivolumab completed 15 weeks of QoL assessment.

Adjusted mean differences between the treatment groups were significant and clinically meaningful, defined as a difference of 10 points or greater, in favor of nivolumab for role functioning, social functioning, fatigue, dyspnea, and appetite loss at both weeks 9 and 15. Investigators also observed significant and clinically meaningful differences favoring nivolumab for diarrhea week 9, and at week 15 for physical functioning, cognitive functioning, and insomnia.

Nivolumab significantly delayed median time to deterioration compared with investigator’s choice for pain, sensory problems, social contact problems, and mouth opening problems on the EORTC QLQ-H&N35 questionnaire. Patients in the nivolumab group reached median time to clinically meaningful increase in weight, but not in the investigator’s choice group.

The EQ-5D VAS, a measure of the patient’s overall health status, was similar between groups at baseline for the analytical cohort (n = 124) and all-randomized population. However, patients in the nivolumab group had a clinically meaningful improvement, defined as a difference of ≥7 points, in adjusted mean change in VAS score from baseline to week 15 compared with clinically meaningful deterioration in the investigator’s choice group (7.3 vs -7.8). The difference between groups at week 15 favoring nivolumab was both significant and clinically meaningful. Median time to deterioration on the EQ-5D VAS was not significantly different between the treatment groups.

CheckMate-141 was an international, phase III, randomized, open-label study investigating comparing overall survival (OS) with nivolumab versus single-agent therapy of investigator’s choice in patients with platinum-refractory recurrent or metastatic HNSCC. Patients were treated at 66 sites in 15 countries in North America, Asia, Europe, and South America.

Patients with cancer of the oral cavity, pharynx, or larynx were randomly assigned to 3 mg/kg nivolumab every 2 weeks (n = 240) or investigator’s choice of cetuximab (12.4%), methotrexate (44.6%), or docetaxel (43%; N = 121). Cetuximab was administered at 400 mg/m2 for the first dose followed by 250 mg/m2 weekly. Methotrexate was administered at 40 mg/m2weekly. Docetaxel was administered at 30 mg/m2 weekly.

Median age was 60 years, and 31.3% were ≥65 years of age. Most patients were male (83%), Caucasian (83%), and had an ECOG PS of 1 (78.4%). Most patients received ≥2 prior systemic therapies (54.8%), and over 90% had received prior radiation therapy. HPV status was known for 49.3% of patients, using p16 status, and PD-L1 expression was available for 72% of enrolled patients.

In survival data first presented at the 2016 ASCO Annual Meeting, the median OS was 7.5 months with nivolumab compared with 5.1 months with investigator’s choice (HR, 0.70; 95% CI, 0.51-0.96; P = .0101). The objective response rate (ORR) was 13.3% with nivolumab and 5.8% for investigator’s choice.2

The 1-year OS rates were 36% with nivolumab (95% CI, 28.5-43.4) compared with 16.6% for investigator’s choice (95% CI, 8.6-26.8). Similar improvements in survival were seen across demographic subgroups. The median progression-free survival (PFS) was 2.0 months with nivolumab versus 2.3 months with investigator’s choice (HR, 0.89; 95% CI, 0.70-1.10; P = .3236). The 6-year PFS rates were 19.7% for nivolumab and 9.9% for investigator’s choice of therapy.

Writing in an accompanying editorial, Susanne Singer, PhD, chair of the division of Epidemiology and Health Services Research at the Institute of Medical Biostatistics, Epidemiology and Informatics of University Medical Centre of Johannes Gutenberg-University Mainz, listed three caveats about the QoL findings: 1) new drugs have different toxicity profiles than standard chemotherapy and that may affect QoL domains that are not covered by standard instruments; 2) there were no hypotheses and many tests were done without adjustment for multiplicity because the QoL analysis was exploratory, so these results should not be given the same weight as a confirmatory analysis; and 3) Baseline QoL may not be an appropriate metric because patients with advanced disease and poor QoL usually drop out from trials more frequently than do patients with better QoL.3

“Bearing these limitations in mind, Checkmate-141 offers valuable insight into the potential effects of nivolumab on certain QoL domains in patients with advanced head and neck cancer who are reasonably fit (ECOG performance status of 0 or 1),” she wrote. “Domains that are most important to patients with head and neck cancer according to an international EORTC study are worrying, swallowing, talking, eating, sticky saliva, dry mouth, and pain in the mouth. In all of these areas, patients treated with nivolumab reported better QoL both 9 and 15 weeks after than patients treated with investigator’s choice.”

Notes:
1.Harrington KJ, Ferris RL, Blumenschein G, et al. Nivolumab versus standard, single-agent therapy of investigator’s choice in recurrent or metastatic squamous cell carcinoma of the head and neck (CheckMate 141): health-related quality-of-life results from a randomised, phase 3 trial [published online June 23, 2017]. Lancet Oncol. doi: 10.1016/S1470-2045(17)30421-7.

2.Ferris RL, Blumenschein GR, Fayette J, et al. Further evaluations of nivolumab (nivo) versus investigator’s choice (IC) chemotherapy for recurrent or metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN): CheckMate 141. J Clin Oncol. 2016;34 (suppl; abstr 6009).

3.Singer S. Quality of life after nivolumab treatment for head and neck cancer [published online June 23, 2017]. Lancet Oncol. doi: 10.1016/S1470-2045(17)30463-1.

Print Friendly, PDF & Email

An artistic representation of cancer

Source: www.vueweekly.com
Author: Stephan Boissonneault

Obstructed by Jude Griebel // Stephan Boissonneault

One of the most terrifying phrases known to our current human existence is “you have cancer.” Those three words can break a person.

“I would describe it as a terrible cyclone of information,” says head and neck cancer patient Kimberly Flowers. “You’re surrounded by all these medical teams, all these procedures and appointments, and you’re expected as [a] patient to make the best informed decisions while you’re in a state of emotional trauma. It’s just a whirlwind of confusion.”

With their project and exhibition See Me, Hear Me, Heal Me, clinicians, researchers, patients, and artists aim to recreate that initial confusion and the universal experience of head and neck cancer with multiple works of art.

“I thought art was the best way to express this because art presents an effective and visceral understanding to the experience,” head researcher of the project Dr. Minn Yoon says.

Yoon, being an assistant professor with the School of Dentistry at the University of Alberta, initially started the project by interviewing patients with head and neck cancer.

“My research has to do with the oral health of vulnerable populations, and patients with head and neck cancer fall into that category,” Yoon says. “I wanted to get a sense of what these people actually go through and how their lives change after learning they have head and neck cancer.”

After an interview with a patient who had undergone surgery to reconstruct her tongue, Yoon became aware that the project did not have to be confined to the realm of academia.

“Words alone were not sufficient,” Yoon says.

After meeting local artist Sean Caulfield, Yoon realized she had found the perfect medium to convey a new and authentic take on head and neck cancer—art.

Having done past work with biomedical art projects, Caulfield jumped on board. The project touched him not only on an artistic level, but also a very personal one.

“My mother had head and neck cancer so I had that personal experience,” Caulfield says.

His piece, “Veil,” is made up of nine wooden panels, each with its own unique image like a bouquet of flowers, lamps, and a suburban house. The images are clouded with sheets of printed disruption, blown up images of cancer cells that look as if they’re slowly consuming the entire piece.

“I started thinking about the memories of my mother and the classic hospital layout,” Caulfield says. “I thought about the ways this diagnoses creates a veil over the way you see your life.”

Similarly, Jill Ho-You’s piece, “Veils”, features hand cut mylar sheets of cancer MRI scans.

“I wanted to use a material that had the same ghostly presence as the MRI scans did,” Ho-You says. “I wanted to express the fragility of the human body. People don’t really ever think about their bodies when everything is fine, but when you get sick it becomes this weird alien experience.”

Like all of the artists featured in the exhibit, Caulfield and Ho-You’s goals were to create relatable imprints for head and neck cancer patients.

“It perfectly conveys what I experienced when I was told I had tongue cancer,” Flowers says. “Everything just seemed black to me and everything was so closed to me. I was existing at work and at home, but I was so numb to everything around me. You’re constantly grasping for the past.”

All of the pieces created in See Me, Hear Me, Heal Me were created after patients, artists, clinicians, and researchers all worked together to find the ubiquitous and invisible aspects of head and neck cancer.

“We had a workshop where we used something called imagery theatre where everyone involved, including the artists, got together and talked about head and neck cancer,” Yoon says.

“What really surprised me was that these artists were able to create something from someone else’s experience and brought a new accurate perspective,” Flowers adds.

Each piece in the exhibit stands out with its own literal spotlight.

There’s Jude Griebel’s “Obstructed” sculpture which features a patient on a hospital bed depicted as a grotesque anthropomorphic mountain that has just had a landslide. The piece chimes in on a person’s loss of identity when being diagnosed with head and neck cancer.

Another piece portraying that loss of identity is Brad Necyk’s “Waiting Room” which shows Flowers’ face digitally blurred out on a lit up background.

“My arm was used to repair my tongue and my leg skin was used to cover my arm,” Flowers says. “You come out quite fractured and your sense of self really changes.”

The exhibit does a superb job of expressing the hidden qualities of head and neck cancer.

“My experience has been very eye-opening, and through the exhibit I’ve had some enlightened moments with my own recovery with head and neck cancer,” Flowers says.

Yoon and the artists hope to soon unveil the exhibit internationally and use it as a means to promote the understanding of head and neck cancer.

“What has happened behind the scenes with these patients has been really moving to me as a researcher, but also as a human,” Yoon says. “I guess that shows the importance of fostering the humanistic qualities of academia, health, and art.”

Print Friendly, PDF & Email

House Committee Looks to Dilute Tobacco Control Act

Source: www.medpagetoday.com
Date: July 12, 2017
Author: Salynn Boyles

The U.S. House Appropriations Committee made a move Wednesday to greatly weaken the FDA’s authority to regulate tobacco products, including flavored cigars and electronic cigarettes, and health advocacy groups were quick to condemn it.

The committee approved a rider to the agriculture funding bill that would exempt certain cigars from FDA’s authority and weaken its regulatory oversight over e-cigarettes, little cigars, and hookah tobacco.

Prior to the vote, the House committee defeated an amendment by Rep. Nita Lowey (D-N.Y.) to remove language from the bill that will effectively eliminate FDA’s authority to review the health hazards of thousands of tobacco products.

A second rider would exempt from FDA authority certain cigars, including many that are cheap, flavored and are most likely to appeal to children, said American Lung Association (ALA) President Harold Wimmer.

“These dangerous riders were added to this bill for the benefit of the tobacco industry and come at a time when e-cigarettes are the most commonly used tobacco product among kids,” Wimmer said in a written press statement.

The riders are similar to those passed by the House Appropriations Committee last year, but the language restricting FDA’s authority under the Tobacco Control Act was dropped from the final FY2017 bill later in the appropriations process. New language in the FY2018 bill does require the FDA to develop standards for the flavors added to e-cigarettes.

ALA spokesperson Erika Sward told MedPage Today that it is not clear if the riders will suffer the same fate this time around.

“Last year there was a President committed to the Tobacco Control Act in the White House,” she said. “This year not only do you have the House attempting to undermine the Tobacco Control Act, but you also have the FDA delaying the deeming rule.”

Nancy Brown, CEO of the American Heart Association, said the cigar rider exempting certain cigars from FDA regulation was particularly troubling.

“Our association strongly believes that the FDA should regulate all products, since tobacco in any form presents health risks. Further, we are particularly concerned that this could create a loophole that would allow tobacco manufacturers to manipulate their products to evade the agency’s oversight,” she said in a written statement.

Brown noted that the tobacco product grandfather rider could allow thousands of tobacco products to skip FDA review.

“While we appreciate that House members included a requirement that the FDA develop a product standard for flavors in e-cigarettes, changing the grandfather date puts e-cigarette users’ health at risk,” she said.

Chris Hansen, president of the American Cancer Society Action Network, charged that the legislation would benefit the cigar and e-cigarette industries at the expense of the nation’s public health.

“Congress made a commitment to protect the health of the American people when it passed the Tobacco Control Act. Today’s committee action is a serious breach of that promise,” he said.

Print Friendly, PDF & Email
July, 2017|Oral Cancer News|